[104-10222-10005.pdf — page 245]
# SECRET## FIELD REASSIGNMENT QUESTIONNAIRE| DO NOT COMPLETE                                                                                                                                                  | FOR READIAJARTERS USE OBLY            || ---------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------- || NAME OF EMPLOYEE (use posude only I SAJ                                                                                                                          | DATE(1100 110 S. OF Superiisse ferue) || Thomas J. Keenan                                                                                                                                                 | 25 Νον, 1968                          || DATE RECEIVED AT HEADQUARTERS                                                                                                                                    | Ding Plonzio                          || DISPATCH M                                                                                                                                                       | DATE (from 10.2)                      || HLBT-3912                                                                                                                                                        | 25 Nov. 1968                          || DATE PECEIVED BY CADILO SEA                                                                                                                                      |                                       ||                                                                                                                                                                  | *signature*                           || **TO BE COMPLETED BY DOLOYZE**                                                                                                                                   |                                       || 1. DATE OF BIRTH                                                                                                                                                 | 2. SERVICE DESION                     || 29 June 1930                                                                                                                                                     | Ops Officer, G8-13                    || 5a. DATE OF PCS ARRIVAL IN FIELD                                                                                                                                 | 5b. REQUESTED DATE OF DEPARTURE       || 28 June 1967                                                                                                                                                     |                                       || 7. NUMBER AND AGED OF DEPENDENTS WHO WILL TRAVEL WITH YOUS                                                                                                       |                                       || Total 7 dependents: Ages- 34, 11, 10, 8, 7, 6,                                                                                                                   | 4                                     || 8. PERSONAL CIRCUMSTANCES THAT SHOULD DE CONSIDERED IN DETERMICING CASTI                                                                                         |                                       ||                                                                                                                                                                  |                                       || 9. LIST YOUR MAJOR CUTIES DURING CURRENT YOUR (200 special note on transmittel fore). (elso attach personal cover questionnaire in accordance with C31.7 240:8). |                                       || Soviet, Communist Party, Audio and Support type operations.                                                                                                      |                                       || 10. TRAINING: DESEDED                                                                                                                                            |                                       || INDICATE BAT TRAINING YOU BELIEVE YOU SHOULD HAVE OUDEN AFRT SEVEREL FRANS                                                                                       |                                       || Clandestine Services Review, Short report writing review course                                                                                                  |                                       |SECRET